两种白内障手术联合Toric IOL植入术在长眼轴患者中的应用

Application of two kinds of cataract surgeries combined with Toric IOL implantation in patients with long ocular axis

摘要:

目的：观察飞秒激光辅助白内障手术(FLACS)与传统白内障手术(Phaco)联合Toric IOL植入术在眼轴大于24mm的患者中的应用疗效。

方法：前瞻性研究。选取2017-01/2018-03在我院行手术治疗的白内障患者49例49眼，飞秒组行FLACS术联合Toric IOL植入术，传统组行Phaco术联合Toric IOL植入术。观察两组患者视力、散光度、斯特列尔比(strchl)、高阶像差情况。

结果：术后3mo，飞秒组和传统组患者视力(0.092±0.089和0.131±0.096)均较术前(0.855±0.213和0.948±0.135)显著改善(P<0.05)，但两组之间视力、总残余散光、strchl值、角膜和全眼高阶像差均无差异(P>0.05)。飞秒组全眼4mm瞳孔直径下4s3、4s4、4Total和6mm瞳孔直径下6s5与strchl值均呈负相关，传统组全眼4mm瞳孔直径下4s3、4Total和6mm瞳孔直径下6s3、6s3+s5、6Total与strchl值均呈负相关。

结论：眼轴大于24mm的白内障患者植入Toric IOL能有效矫正角膜规则散光，FLACS术和传统超声乳化手术均能使其保持眼内旋转稳定性，显著改善术后视觉质量。

Abstract:

AIM: To compare the clinical observations of patients with cataract axis longer than 24mm who underwent either femtosecond laser or traditional cataract surgery combined with Toric intraocular lens.

METHODS: Prospective study. The subjects were patients with cataract eyes with axis length longer than 24mm who underwent ocular cataract surgery and toric IOL implantation in our hospital. They were divided into femtosecond phaco groups. Clinical observations included uncorrected visual acuity, best corrected visual acuity, and changes in corneal and intraocular high-order phase difference.

RESULTS: The best corrected visual acuity of the two groups 3mo after surgery(0.092±0.089, 0.131±0.096)was significantly higher than that before surgery(0.855±0.213, 0.948±0.135)(P<0.05). The difference between the high-order cornea and the entire eye of the two groups was not significant(P>0.05). In the femtosecond group, the strchl values were negatively correlated with 4s3, 4s4, and 4Total in the 4mm pupil diameter of the entire eye and with the 6s5 at 6mm pupil diameter. The strchl values were also negatively correlated with 4s3 and 4Total in the 4mm pupil diameter of the entire eye in the traditional group and with 6s3, 6s3+s5, and 6Total under the 6mm pupil diameter.

CONCLUSION: Implantation of Toric IOL in patients with cataract greater than 24mm can effectively correct corneal regular astigmatism. Both FLACS and conventional phacoemulsification can maintain intraocular rotational stability and significantly improve postoperative visual quality.